| NPI | 1558641472 |
|---|---|
| Doing Business As | BRIAN ARCENEAUX/EDWINA SMITH |
| Entity Type | Organization |
| Authorized Contact | EDWINA LEIGH SMITH Program Manager 682-472-4680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2011-08-23 |